NUTRITION

YUAN, ASHLEY& CARLA

Nutrition is the sum of all the interactions between an
organism and the food it consumes. In other words, nutrition
is what a person eats and how the body uses it.
Nutrients are organic and inorganic substances found in
foods that are required for body functioning.
Nutrients have three major functions: providing energy for
body processes and movement, providing structural material
for body tissues, and regulating body processes.
The body’s most basic nutrient need is water.
Carbohydrates, fats, protein, minerals, vitamins, and water
are referred to as macronutrients, because they are needed
in large amounts (e.g., hundreds of grams) to provide energy.
Micronutrients are those vitamins and minerals that are
required in small amounts (e.g., milli- grams or micrograms)
to metabolize the energy-providing nutrients.
 Carbohydrates
Carbohydrates are composed of the elements carbon (C), hydrogen (H), and oxygen (O) and are of two basic types: simple
carbohydrates (sugars) and complex carbohydrates (starches and fiber).
Natural sources of carbohydrates also supply vital nutrients, such as protein, vitamins, and minerals that are not found in
processed foods.
Processed carbohydrate foods are relatively low in nutrients in relation to the large number of calories they contain.
High sugar-content (and solid fat) foods are referred to as “empty calories.” In addition, alcoholic beverages contain significant
amounts of carbohydrate, but very few nutrients and, thus, they are also empty calories.

TYPES OF CARBOHYDRATES
SUGARS Sugars, the simplest of all carbohydrates, are water soluble and are produced naturally by both plants and animals. Sugars
may be monosaccharides (single molecules) or disaccharides (double molecules). Of the three monosaccharides (glucose, fructose, and
galactose), glucose is by far the most abundant simple sugar.

STARCHES Starches are the insoluble, nonsweet forms of carbohydrate. They are polysaccharides; that is, they are composed of
branched chains of dozens, sometimes hundreds, of glucose molecules. Like sugars, nearly all starches exist naturally in plants, such as
grains, legumes, and potatoes. Other foods, such as cereals, breads, flour, and puddings, are processed from starches.

FIBER Fiber, a complex carbohydrate derived from plants, supplies roughage, or bulk, to the diet. However, fiber cannot be digested by
humans. This complex carbohydrate satisfies the appetite and helps the digestive tract to function effectively and eliminate waste.
Fiber is present in the outer layer of grains, bran, and in the skin, seeds, and pulp of many vegetables and fruits.
 Protein
Amino acids, organic molecules made up primarily of carbon, hydrogen, oxygen, and nitrogen, combine to form proteins.
Every cell in the body contains some protein, and about three quarters of body solids are proteins.

Amino acids are classified as essential or non essential.

Essential amino acids are those that cannot be manufactured in the body and must be supplied as part of the protein
ingested in the diet. Nine essential amino acids—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, tryptophan,
threonine, and valine— are necessary for tissue growth and maintenance. A tenth, arginine, appears to have a role in the
immune system.

Nonessential amino acids are those that the body can manufacture. The body takes amino acids derived from the diet and
reconstructs new ones from their basic elements. Nonessential amino acids include alanine, aspartic acid, cystine, glutamic
acid, glycine, hydroxyproline, proline, serine, and tyrosine.

Proteins may be complete or incomplete.

Complete proteins contain all of the essential amino acids plus many nonessential ones. Most animal proteins, including
meats, poultry, fish, dairy products, and eggs, are complete proteins. Incomplete proteins lack one or more essential
amino acids (most commonly lysine, methionine, or tryptophan) and are usually derived from vegetables.
 Lipids
Lipids are organic substances that are greasy and insoluble in water but soluble in alcohol or ether. Fats are lipids that are
solid at room temperature; oils are lipids that are liquid at room temperature. In common use, the terms fats and lipids are
used interchangeably. Lipids have the same elements (carbon, hydrogen, and oxygen) as carbohydrates, but they contain
a higher proportion of hydrogen.

Fatty acids, made up of carbon chains and hydrogen, are the basic structural units of most lipids. Fatty acids are described
as saturated or unsaturated, according to the relative number of hydrogen Fatty acids, made up of carbon chains and
hydrogen, are the basic structural units of most lipids. Fatty acids are described as saturated or unsaturated, according to
the relative number of hydrogen.

Saturated fatty acids are those in which all carbon atoms are filled to capacity (i.e., saturated) with hydrogen; an example
is butyric acid, found in butter.

An unsaturated fatty acid is one that could accommodate more hydrogen atoms than it currently does. It has at least two
carbon atoms that are not attached to a hydrogen atom; instead, there is a double bond between the two carbon atoms.

Cholesterol is a fatlike substance that is both produced by thebody and found in foods of animal origin. Most of the body’s
cholesterol is synthesized in the liver; however, some is absorbed from the diet (e.g., from milk, egg yolk, and organ
meats). Cholesterol is needed to create bile acids and to synthesize steroid hormones. Along with phospholipids, large
quantities of cholesterol are present in cell membranes and other cell structures.
Metabolism refers to all biochemical and physiological processes by which the body grows and
maintains itself. Metabolic rate is normally expressed in terms of the rate of heat liberated during
these chemical reactions.

The basal metabolic rate (BMR) is the rate at which the body metabolizes food to maintain the energy
requirements of a person who is awake and at rest. The energy in food maintains the basal metabolic
rate of the body and provides energy for activities such as running and walking.

Resting energy expenditure (REE) is the amount of energy required to maintain basic body functions; in
other words, the calories required to maintain life. The REE of healthy individuals is generally about 1
cal/kg of body weight/h for men and 0.9 cal/kg/h for women although there is great variation among
individuals. BMR is calculated by measuring the REE in the early morning, 12 hours after eating.

For people older than 18 years, the body mass index (BMI) is an indicator of changes in body fat stores
and whether a person’s weight is appropriate for height, and may provide a useful estimate of
malnutrition.

Ideal body weight (IBW) is the optimal weight recommended for optimal health.
FACTORS INFLUENCING A PERSON'S NUTRITION

DEVELOPMENT
GENDER/SEX
ETHNICITY AND CULTURE
BELIEFS ABOUT FOOD
PERSONAL PREFERENCES
RELIGIOUS PRACTICES
LIFESTYLE
ECONOMICS
HEALTH
MEDICATIONS AND THERAPHY
ALCOHOL CONSUMPTION
ADVERTISING
PSYCHOLOGICAL FACTORS
Nutritional needs vary considerably according to age, growth, and energy
requirements. Adolescents have high energy requirements due to their rapid growth; a
diet plentiful in milk, meats, green and yellow vegetables, and fresh fruits is required.
Middle-aged adults and older adults often need to reduce their caloric intake because
of decreases in metabolic rate and activity levels.

Various daily food guides have been developed to help healthy people meet the daily
requirements of essential nutrients and to facilitate meal planning. These include the
Dietary Guidelines for Americans and the Food Guide Pyramid/MyPlate. The Food Guide
Pyramid is a graphic aid developed by the USDA as a guide in making daily food
choices. On the pyramid, the food groups—grains, vegetables, fruits, milk, and meat
and beans—are drawn from the base of the pyramid to the apex. This indicates that
activity, moderation, personalization, proportionality, variety, and gradual
improvement are the keys to good nutrition.
ALTERED NUTRITION

Malnutrition is commonly defined as the lack of necessary or appropriate food

substances, but in practice includes both undernutrition and overnutrition.

Overnutrition refers to a caloric intake in excess of daily energy requirements, resulting

in storage of energy in the form of adipose tissue.

A person is said to be overweight when the BMI is between 25 and 29.9 kg/m2
and obese when the BMI is >30 kg/m2

Undernutrition refers to an intake of nutrients insufficient to meet daily energy

requirements because of inadequate food intake or improper digestion and absorption
of food.

Protein-calorie malnutrition (PCM), seen in starving children of underdeveloped

countries, is now also recognized as a significant problem of clients with long-term
deficiencies in caloric intake (e.g., those with cancer and chronic disease).
Assessment of nutritional status may involve all or some of the following: nutritional
screening, nursing history data, anthropometric measurements, biochemical
(laboratory) data, clinical data (physical examination), calculation of the percentage of
weight loss, and a dietary history.

Major goals for clients with or at risk for nutritional problems include the following:
Maintain or restore optimal nutritional status, decrease or regain specified weight,
promote healthy nutritional practices, and prevent complications associated with
malnutrition
.
Assisting clients and support persons with therapeutic diets is a function shared by the
nurse and the dietitian. The nurse reinforces the dietitian’s instructions, assists the
client to make beneficial changes, and evaluates the client’s response to planned
changes. Because many hospitalized clients have poor appetites, a major responsibility
of the nurse is to provide nursing interventions that stimulate their appetites.
Whenever possible, the nurse should help incapacitated clients to feed themselves; a
number of self-feeding aids help clients who have difficulty handling regular utensils.
The nurse can refer clients to various community programs that help special subgroups
of the population meet their nutritional needs.

Special Community Nutritional Services

Enteral Nutrition

Alternative feeding methods that ensure adequate nutrition include enteral (through
the GI system) methods. Enteral nutrition (EN), also referred to as total enteral
nutrition (TEN), is provided when the client cannot ingest foods or the upper GI tract is
impaired and the transport of food to the small intestine is interrupted. Enteral
feedings are administered through nasogastric and small-bore feeding tubes, or
through gastrostomy or jejunostomy tubes.

Enteral feedings, administered through nasogastric, nasointestinal, gastrostomy, or

jejunostomy tubes, are provided when the client is unable to ingest foods or the upper
GI tract is impaired.
A nasogastric tube is inserted through one of the nostrils, down the nasopharynx, and
into the alimentary tract. Traditional firm, large-bore nasogastric tubes (i.e., those
larger than 12 Fr in diameter) are placed into the stomach. Examples are the Levin
tube, a flexible rubber or plastic, single-lumen tube with holes near the tip, and the
Salem sump tube, with a double lumen.

A nasoenteric (nasointestinal) tube, a longer tube than the nasogastric tube (at least
40 cm [15.75 in.] for an adult), is inserted through one nostril down into the upper small
intestine. Some agencies require specially trained nurses or primary care providers to
perform this procedure. Nasoenteric tubes are used for clients who are at risk for
aspiration.

Gastrostomy and jejunostomy devices are used for long-term nutritional support,
generally more than 6 to 8 weeks. Tubes are placed surgically or by laparoscopy
through the abdominal wall into the stomach (gastrostomy) or into the jejunum
(jejunostomy). The two most accurate methods of confirming GI tube placement
are radiographs and pH testing of aspirate.
Parenteral Nutrition

Parenteral nutrition, also referred to as total parenteral nutrition (TPN)

or intravenous hyperalimentation, is the IV infusion of dextrose, water,
fat, proteins, electrolytes, vitamins, and trace elements. Because TPN
solutions are hypertonic (highly concentrated in comparison to the
solute concentration of blood), they are injected only into high-flow
central veins, where they are diluted by the client’s blood.

Parenteral nutrition, provided when oral intake is insufficient or

unadvisable, is given intravenously into a large central vein (e.g., the
superior vena cava).